Hemangiopericytoma of the Tracheal Wall

Abstract

hemangiopericytoma occurred on the posterior tracheal wall in a 46-year-old man. A review of the pathologic findings showed that compressed groups of capillaries were lined by an intact reticulin sheath that was surrounded by spindleshaped pericytes. The ultramicroscopic findings of small spindle cells with a surrounding basal lamina and intracellular microfilaments in the absence of neurosecretory granules are important diagnostic features. Emphasis is placed on the impossibility of differentiating benign and malignant lesions pathologically, the need for long-term clinical follow-up, and the necessity for adequate complete surgical resection of these lesions. The use of a surgical approach to the posterior side of the tracheal wall can prevent postoperative stenosis. (Arch Otolaryngol 1981;107:558-560) Hemangi operi cytoma of the head and neck is a rare neoplasm that accounts for approximately 1% of all vascular neoplasms in this region. Anatomically, hemangiopericytomas are widely distributed, with about a third occurring in the head and neck region. The nasal cavity and ethmoid sinuses are the most common locations for hemangiopericytomas, followed by occasional reports of tumors that Reprint requests to the Section of Facial Plastic and Otolaryngology Surgery, The Mason Clinic, Seattle, WA 98111 (Dr Yarington). occur in the tongue, larynx, nasophar¬ ynx, maxilla, buccal sulcus, parotid region, and infratemporal fossa. To our knowledge, there has been only one previous case report of a heman¬ giopericytoma occurring in the tra¬ chea by Bremond and Garcia1; there¬ fore, the present report represents the second case of such a tumor occurring along the posterior side of the trachéal wall at the second trachéal ring. REVIEW OF LITERATUREIn 1873, Rouget-described a special cell in the pericapillary space that he termed "cellules adventices," which subsequently became known as "Rou¬ get cells." In 1923, Zimmermann' re¬ named these cells "pericytes." In 1942, Murray and Stout1 showed, by tissue culture techniques, that these cells were identical to the epithelioid cells of the glomus tumor. In their review of vascular tumors, Murray and Stout1 reported nine cases that were appar¬ ently derived from pericytes but could not be classified as glomus tumors or the other classes of vascular tumors; these tumors were named "hemangio¬ pericytomas."5 REPORT OF A CASEA 46-year-old man had a three-month history of a sore throat, especially when he coughed and swallowed. The examination done by the patient's referring physician included a roentgenogram of the lateral soft-tissue in the neck region (Fig 1), which showed a mass that arose from the posteri¬ or side of the trachea! wall at the level of the second trachéal ring. Bronchoscopy and biopsies were done by the referring physi¬ cian on Dec 15, 1975; the result of these studies was reported as "acute and chronic inflammation." Subsequently, these pa¬ thology slides were reviewed and consid¬ ered to be nondiagnostic.The patient was then referred to The Mason Clinic, Seatt...

Hemangiopericytoma of the trachea

“…Malignant lesions of the trachea are rare tumours, and among them hemangiopericytomas are exceptional. To our knowledge there have been only three other cases of a hemangiopericytoma occurring in the trachea (Alvarez-Vicent, 1969;Bremond et al, 1975;Ballard and Yarington, 1981). The case reported by Bremond et al (1975) and our own case showed a very similar behaviour, much more aggressive than the cases mentioned by Alvarez-Vicent (1969) and Ballard and Yarington (1981).…”

“…Since the report in 1762 of a tracheal tumour by Morgagni (Morgagrii, 1769) there have been fewer than 400 cases of tracheal cancers reported in the literature, most of them (60 per cent) arising from the posterior and lateral walls of the trachea (Houston et al, 1969). Only three of these tumours were hemangiopericytomas (Alvarez-Vicent, 1969;Bremond et al, 1975;Ballard and Yarington, 1981), two of them confirmed by electron microscopic study (Bremond et al, 1975;Ballard and Yarington, 1981).…”

“…These tumours were derived from the 'cellules adventices' described in 1873 by Rouget, and renamed in 1923 by Zimmermann as 'pericytes'. Hemangiopericytoma of the head and neck accounts for approximately 1 per cent of all vascular neoplasms in this region (Ballard and Yarington, 1981). The nasal cavity and ethmoid sinuses are the most common locations for hemangiopericytoma of the head and neck (Manos-Pujol et al, 1984).…”

Inflammatory pseudotumour of the trachea: report of a case in an eight-year-old child

“…Among the benign mesenchymal tumours the reported entities have included fibromas (Gilbert et al, 1953;MacLachlan, 1968), fibromyxoma (Pollak et al, 1985), fibrous histiocytoma (Sandstorm et al, 1978), granular cell tumour (Mikaelian etal., 1984), leiomyoma (Harris et al, 1967), and neurilemmoma (Horovitz etal., 1983). Paraganglioma (Liew etal., 1981), haemangiopericytoma (Ballard and Yarington, 1981) and hamartoma (Engelking, 1959) are also exceedingly rare lesions. One case of plasma cell granuloma (Satomi et al, 1991) has been reported recently in the subglottic region of a 55-year-old woman and perhaps is closely related to the present case.…”